For more than 50 years, Martyn Pring’s life was dominated by an “uncontrollable” urge to snack, and nothing doctors suggested seemed to help.
It began after an attack of German measles when he was two years old, and from then on Martyn, now in his sixties, would regularly feel overwhelmed by the need to scratch his skin until it was raw and bleeding.
The sensation affected every part of his body except his face, regularly disrupting his sleep, and even as an adult he had to wear gloves in bed to try to stop his incessant scratching.
“I’ve been tried every emollient cream (medicated moisturizer), lotion and medication there is, but nothing worked,” says Martyn, a university researcher and author, who lives with his wife in Swanage, Dorset.
‘I was hospitalized with itching for two weeks on more than one occasion.
Martyn Pring suffered from chronic itching for more than 50 years, from the age of two
‘They covered me with bandages and bathed me with emollient creams (medical moisturizers) and bandaged me so tightly that I had to stay in bed.
“But the itch always came back.”
It was in 2018, more than five decades after the itch began, diagnosed as eczema, that his dermatologist suggested Martyn participate in a clinical trial of a new treatment called dupilumab (brand name Dupixent). This treatment can be administered to patients whose eczema has not responded to other treatments and works by preventing the immune system from overreacting, reducing inflammation.
For Martyn, the beatings he now receives every fortnight at his GP surgery have “changed my life in a way I can’t describe”.
“No one knows how unbearable chronic itch is until you experience it,” he adds.
About one in six (17 percent of us) suffer from generalized itching (all over the body, rather than just one place) without an obvious skin condition; This figure is thought to increase to half of older people, according to the Society for Primary Care Dermatology.
Causes range from allergies to liver or kidney problems, diabetes, and in rare cases, cancer.
Last year, scientists at Harvard Medical School discovered that a common microbe that lives on the skin, Staphylococcus aureus, could be responsible for the persistent itching suffered by those with skin conditions such as eczema.
Their research, based on animal studies, revealed that the microbe, which normally lives harmlessly in about 30 percent of people, can be found in higher quantities in some people with eczema. They release a chemical, V8 protease, which activates a protein (PAR1) in the nerves in the skin: once activated, it transmits signals from the skin to the brain, triggering the urge to scratch.
Conditions such as eczema, hives and psoriasis also cause inflammation, which results in the release of chemicals by immune cells known as cytokines: they recruit other immune cells to the site, causing nerve cells in the skin to send messages to the brain, causing an itchy sensation. explains Dr Haytham Al-Rawi, consultant dermatologist at University Hospitals Birmingham NHS Foundation Trust.
As for people who don’t have a skin condition, the most common cause of itching is dry skin, explains Dr Elise Kleyn, consultant dermatologist at Salford Royal NHS Foundation Trist and spokesperson for the British Association of Dermatologists.
This is because dry skin is due to a compromised skin barrier, making it susceptible to irritation, she says.
Some women also find their skin more itchy during and after menopause, as the drop in protective estrogen levels can make it drier.
Whatever the cause, there is a good reason not to scratch when it is itchy, as the more you scratch, the more it irritates the skin, making the itch even more.
“This is known as a positive feedback loop,” says Dr. Al-Rawi. Instead, she advises applying something cool to the area. (Cooling acts on certain nerve fibers, encouraging them to send calming signals to the brain.)
The risk is that scratching can make the problem chronic, as the nerves can become hypersensitive, so “something that doesn’t normally cause itch, such as pressure or touch, can trigger a response and cause widespread itching,” he says. Dr. Al-Rawi.
Alison MacColl developed an itchy left foot after giving birth, which persists 12 years later.
Alison MacColl can relate to this. The mother-of-two developed a bothersome itch around the arch of her left foot after the birth of her daughter Iona, and 12 years later she is still itching in exactly the same spot.
At first he assumed it was due to the heat, since it was summer. “I was so busy concentrating on my baby that I didn’t think much of it,” recalls Alison, 57, an aromatherapist who lives with her husband Alistair, 57, a lawyer, daughter Iona and ten-year-old son. , Angus, in East Kilbride in Scotland.
Alison admits that scratching made things worse: the skin on her foot turned red and formed a blister the size of a golf ball. “It kept itching until the blister burst,” he says.
When the aggravating cycle continued for a year, Alison visited her GP, who prescribed an antifungal cream, which made no difference.
Over the next few years, he saw his doctor three times.
They gave him antihistamine cream in case it was caused by an allergy and hydrocortisone cream (which contains steroids); Neither of them helped. Finally, a stronger hydrocortisone ointment was effective and she now uses it sparingly for breakouts.
The cause of Alison’s itch has not yet been identified, but it appears to be a simple case of itching, but this is not always the case. Generalized itching without a skin condition “could indicate an underlying problem such as kidney disease or liver problems, so this should be investigated,” says Dr Al-Rawi, who is also a consultant dermatologist at Spire Little Aston Hospital.
Kidney problems cause itching as waste products build up in the blood, irritating nerve endings and triggering the “itch response.” Unexplained itching can also be a sign of kidney failure along with anemia, tiredness and nausea, says Dr. Al-Rawi.
Itchy skin can also indicate a malfunctioning liver, he adds: As it struggles to remove bile salts from the blood, they build up under the skin, irritating nerve endings.
This may be due to liver disease or may also occur in the later stages of pregnancy when the liver may not be working as well as usual.
Your GP may suggest blood tests to rule out this or other itch triggers, such as iron deficiency anaemia, thyroid problems and celiac disease (an autoimmune condition with symptoms triggered by eating gluten), but it is not understood completely how they cause itching.
A blood test can also be used to diagnose diabetes, which can cause itching because high blood sugar levels make nerve endings more sensitive.
Medications, such as opioids (morphine and codeine), can cause itching, possibly because they cause the release of excess histamine; The chemical then attaches to the mast cells, causing the blood vessels to expand and the surrounding skin to itch.
Itching may be a symptom of cancer of the blood or lymph nodes, caused by irritation of the nerve endings due to cytokines released by the immune system in response to the cancer. “There will usually be other symptoms, such as weight loss and night sweats,” says Dr. Al-Rawi.
People with anxiety or obsessive-compulsive disorder may also experience itching, thought to be due to a habit or stress coping mechanism.
While itching due to a specific medical condition can be relieved by treating it, it can be difficult to treat an itch where no underlying cause is found, says Dr. Al-Rawi.
Moisturizers are the first line of treatment; The next step is steroid creams and antihistamines (the chemical histamine is released when there is inflammation in the skin, causing the itchy sensation).
Phototherapy, in the form of exposure to UV light in a booth for a few minutes three times a week for about ten weeks, can work because UV light calms the immune system and reduces the inflammatory response.
Sometimes certain antidepressants, such as amitriptyline, are prescribed in low doses because they reduce the sensitivity of nerve endings.
If persistent itching significantly affects someone’s quality of life, immunosuppressants such as methotrexate or cyclosporine may be given, and the last resort, due to cost, is biologic drugs that target the immune response, such as nemolizumab.
“These new therapies are very expensive, but they are the future of medicine: they have revolutionized the treatment of psoriasis, they are helping people with eczema and hives, and they have reportedly helped with generalized itching,” says Dr. Al-Rawi. They work by targeting specific pathways of the immune system, reducing the inflammatory process at an early stage.
Researchers continue to search for new treatments. A new immunotherapy treatment for severe atopic dermatitis and eczema, nemolizumab, which blocks the protein interleukin-31 (IL-31), is being trialed in the UK. IL-31, normally released by the immune system to fight disease-causing organisms, causes both the urge to itch and inflammation of the skin every time it itches.
But can sometimes itching be a good thing?
There’s certainly a reason why some people love scratching their backs: it triggers the release of feel-good hormones such as serotonin, says Dr Bernard Ho, consultant dermatologist at St George’s Hospital, London and spokesperson for the British Skin Foundation.
Itching around a scar after surgery can be a positive sign, indicating that the nerves are regenerating and therefore healing is beginning.
As for Alison, her itch still comes and goes, but she has managed to identify certain triggers, including alcohol and chocolate.
‘I had asthma attacks after eating chocolate eggs at Easter; Some people may have spots on their face from chocolate, but my foot is itchy.
“But luckily I’ve learned to keep it under control.”
Additional reporting: Julie Cook